How accessible is your healthcare?
In 2022, Healthwatch England launched its Your Care, Your Way campaign which aimed to find out whether the Accessible Information Standard (AIS) is being met. This standard gives disabled people and people with a sensory loss the legal right to get health and social care information in an accessible way and receive communications support if they need it. Healthwatch England revealed that many healthcare providers don't meet their duties under the 2016 NHS AIS.
Working with leading charities, Healthwatch England called for NHS England to strengthen the AIS. A revised version is due out this year but while we await its publication, we continue to hear from people and their carers about lack of required support.
Trends in the public feedback
In February, feedback that was shared with Healthwatch England and local Healthwatch highlighted areas of concern that patients with communication needs raised.
Key issues:
- People continue to struggle to access health and care services.
- People continue to struggle to communicate with health and care services, where communication support is difficult and lacking.
- People with communication needs do not always get the adjustments they need, leading to poorer quality of care.
Access to services
Lack of face-to-face appointments
Although face-to-face appointments with healthcare professionals are vital for patients who have a hearing impairment, many noted that they could not access GP face-to-face appointments.
For instance, one person was instructed to undergo additional tests to "prove" they had hearing loss despite being diagnosed with a hearing condition before being able to book a face-to-face appointment.
Some people reported that they had to incur financial costs as they had to arrange communication help themselves.
Issues booking appointments
Some people who have a visual impairment reported that online systems were difficult to use or incompatible with communication software (e.g. screen readers). Some patients struggled to get to new health and care facilities due to not receiving prior information about the need to navigate busy roads, poorly marked pedestrian crossings, and unfamiliar layouts. This resulted in people being late to appointments and putting them in potentially unsafe situations.
People with hearing impairments had difficulty booking appointments over the phone. Often, they weren't offered more accessible appointment booking methods.
Communication with services
Inaccessible formats
People continue to receive information from health services in inaccessible or inappropriate formats. For instance, people with visual impairments told us of receiving hard copy letters instead of digital formats, and people with hearing impairments described receiving phone calls rather than emails or a relay service.
Local Healthwatch also received feedback about the improper use of Braille, small text on medication leaflets, use of complex medical language, and healthcare services refusing to provide patients information in accessible formats.
People who received inappropriate and/or inaccessible information reported feeling disempowered and anxious when they couldn't get the care they needed and if their condition worsened.
Issues booking BSL support
People with hearing impairments reported having issues with services failing to book British Sign Language (BSL) interpreters, leading to cancelled and rebooked appointments.
For instance, some local Healthwatch found that a lack of face-to-face interpreters made it incredibly difficult for people to access the help and treatment they need and there was also confusion around who is responsible for booking interpreters for appointments.
In some cases, there was also an assumption in the NHS that family or friends would step in and meet people's needs to get to appointments, read letters, and more. This assumption can feel disempowering to people without support and takes away confidentiality and independence.
Quality of care
People reported services failing to provide reasonable adjustments that prevented them from either understanding or accessing care. For instance, some people didn't know when they have been called through for their appointments:
- People with visual impairments not being audibly called, or not able to follow the health care professional to the consultation room.
- People with hearing impairment being unable to hear their name and/or being called without visual cues (e.g. call screens).
At the same time, people who have a learning disability reported not being given enough time to explain their needs.
A clear case for change
Healthwatch England’s latest findings are echoed by evidence from national charities supporting people with sensory impairments.
A joint report from RNID and Signhealth published in April, found that seven out of 10 Deaf people and people with hearing loss have never been asked about their information and communication needs when accessing NHS care. Only 24% of NHS staff who answered a survey by the charities said they could always meet the information and communication needs of patients who were deaf or had hearing loss.
Healthwatch England have sat on a working group alongside many charities advising NHS England on how to strengthen the current AIS. The organisation has also called on ministers to publicly state their commitment to ensuring the NHS fully complies with the standard.
Recommendations set out by Healthwatch England are:
- Health and care services should be made accountable for fully delivering the AIS by stronger oversight from commissioners and Care Quality Commission inspections.
- Every health and care service should have an accessibility champion.
- IT systems across the NHS should enable digital flags to be added to patients’ medical records about their communication needs and this information should be shared seamlessly between primary, secondary and other types of services.
- Training on accessible information and disability adjustments should be mandatory and provided to all relevant NHS staff.
- Services should involve people with communication needs in helping them self-assess their compliance with the AIS.
Read more about Healthwatch England’s work on accessible healthcare.
